| NPI | 1518292820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6301014892) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MI 6301011899) |
| Enumeration Date | 2009-10-05 |
| Last Update Date | 2021-11-09 |