| NPI | 1144829037 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MI 6362009236) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: MI PP0000001037037) |
| Enumeration Date | 2020-10-21 |
| Last Update Date | 2020-10-21 |