| NPI | 1497138234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NC 5303) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MI 6301016282) |
| Enumeration Date | 2015-06-29 |
| Last Update Date | 2019-05-17 |