| NPI | 1356749022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MI 6301016091) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NE 10903) |
| Enumeration Date | 2014-12-12 |
| Last Update Date | 2020-12-03 |