| NPI | 1114241585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MI 6301014377) |
| Additional Taxonomies | 103TF0200X Psychologist, Forensic (Licence: MI 6301014377) |
| Enumeration Date | 2010-03-15 |
| Last Update Date | 2019-07-18 |