| NPI | 1386753366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MI 6301016540) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: MI 5901001438) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2019-09-26 |