| NPI | 1285606103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6301019013) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NC 2664) |
| Enumeration Date | 2006-02-03 |
| Last Update Date | 2021-11-17 |