| NPI | 1144599077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6301018944) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: OH P.08021) |
| Enumeration Date | 2011-12-21 |
| Last Update Date | 2023-07-11 |