| NPI | 1093892622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MI 6301005458) |
| Additional Taxonomies | 103TR0400X Psychologist Rehabilitation (Licence: MI 6301005458) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2019-11-11 |