| NPI | 1366998676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TN 3706) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MI 6301016236) |
| Enumeration Date | 2016-08-27 |
| Last Update Date | 2020-10-27 |