| NPI | 1346447422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NM 661) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MI 6301013504) |
| Enumeration Date | 2007-07-02 |
| Last Update Date | 2016-02-29 |