| NPI | 1326267121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MI 6361004793) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MI 4101006301) |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2022-08-06 |