| NPI | 1427482918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: OH 7468) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MI 6301015681) |
| Enumeration Date | 2013-09-03 |
| Last Update Date | 2016-10-10 |