| NPI | 1255324877 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 008189) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MI 63010008189) |
| Enumeration Date | 2005-08-30 |
| Last Update Date | 2021-05-27 |