| NPI | 1528735180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MI 6351004580) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MI 6352000607) |
| Enumeration Date | 2021-08-23 |
| Last Update Date | 2023-05-02 |