| NPI | 1164531851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NC 4105) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NC 4105) |
| 103TC0700X Psychologist, Clinical (Licence: MI 6301011883) | |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2022-11-19 |