| NPI | 1154095065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MI 6362009339) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: MI 6361007778) |
| Enumeration Date | 2021-08-04 |
| Last Update Date | 2023-01-02 |