| NPI | 1568890895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OH P.08433) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MI 6301016474) |
| Enumeration Date | 2013-10-23 |
| Last Update Date | 2023-06-05 |