| NPI | 1144820598 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6301018924) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MI 6301018924) |
| 103T00000X Psychologist (Licence: MI 6351004125) | |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: MI 6301018924) | |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: MI 6351004125) | |
| Enumeration Date | 2020-10-26 |
| Last Update Date | 2022-07-21 |