| NPI | 1235703000 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6301019184) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MI 6361006432) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 6361006432) | |
| 103T00000X Psychologist (Licence: MI 6301019184) | |
| Enumeration Date | 2021-05-17 |
| Last Update Date | 2023-12-15 |