| NPI | 1144964891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6361008262) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: MI 6362009516) |
| Enumeration Date | 2022-04-27 |
| Last Update Date | 2026-07-13 |