| NPI | 1548686124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 103TF0200X Psychologist, Forensic (Licence: MI 6301014325) |
| Enumeration Date | 2014-03-06 |
| Last Update Date | 2022-07-21 |