| NPI | 1467075176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6301019396) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MI 6351004490) |
| Enumeration Date | 2020-05-28 |
| Last Update Date | 2023-10-31 |