| NPI | 1245480961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6301008576) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MI 6361005144) |
| Enumeration Date | 2008-09-30 |
| Last Update Date | 2021-11-24 |