| NPI | 1457827370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MI 6361007659) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MI 6301017647) |
| Enumeration Date | 2018-10-18 |
| Last Update Date | 2023-09-11 |