| NPI | 1437971926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TF0200X Psychologist, Forensic (Licence: MI 6301019571) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MI 6301019571) |
| Enumeration Date | 2024-10-28 |
| Last Update Date | 2024-10-28 |