| NPI | 1245899863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MI 6361007563) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MI 6301017782) |
| Enumeration Date | 2019-06-07 |
| Last Update Date | 2021-03-03 |