| NPI | 1194112052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MI 6301014850) |
| Enumeration Date | 2015-04-17 |
| Last Update Date | 2015-04-17 |