| NPI | 1538413000 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6361006732) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MI 6301015258) |
| 103T00000X Psychologist (Licence: MI 6301015258) | |
| Enumeration Date | 2012-11-05 |
| Last Update Date | 2020-04-30 |