| NPI | 1508235235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MI 6301016488) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MI 6301016488) |
| Enumeration Date | 2015-09-23 |
| Last Update Date | 2019-02-13 |