| NPI | 1316375595 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OH 07781) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MI 6301014600) |
| Enumeration Date | 2013-10-24 |
| Last Update Date | 2022-07-27 |