| NPI | 1205984887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6301010476) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MI 6361002554) |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2021-09-15 |