| NPI | 1497883979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251S00000X (Licence: MI 6301011431) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MI 6361005054) |
| Enumeration Date | 2007-02-28 |
| Last Update Date | 2021-09-09 |