| NPI | 1295196152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TH0100X Psychologist, Health Service |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MI 6401014593) |
| 103TH0100X Psychologist, Health Service (Licence: LA 1544) | |
| Enumeration Date | 2016-03-18 |
| Last Update Date | 2022-09-27 |