| NPI | 1356691158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MI 6301015232) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MI 6301015232) |
| Enumeration Date | 2012-09-19 |
| Last Update Date | 2021-07-06 |