| NPI | 1467765727 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6361006522) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MI 6301005381) |
| Enumeration Date | 2010-07-15 |
| Last Update Date | 2024-09-20 |