| NPI | 1104276690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MI 6301017242) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MI 6301016665) |
| Enumeration Date | 2016-06-15 |
| Last Update Date | 2018-10-01 |