| NPI | 1487027165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MI 6301017931) |
| Additional Taxonomies | 183700000X Pharmacy Technician (Licence: MI 5303009832) |
| Enumeration Date | 2015-11-04 |
| Last Update Date | 2019-06-20 |