| NPI | 1457227035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TS0200X Psychologist, School (Licence: MI SP0000001218473) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: OH LSP.01827) |
| 103TS0200X Psychologist, School (Licence: WA 618313A) | |
| 103TS0200X Psychologist, School (Licence: CA 220138398) | |
| Enumeration Date | 2025-10-13 |
| Last Update Date | 2025-10-13 |