| NPI | 1295084390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MI 6301015374) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MI 6301015117) |
| Enumeration Date | 2012-09-05 |
| Last Update Date | 2012-11-08 |