| NPI | 1578816245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MI 6361006597) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MI 6301015331) |
| 103TC0700X Psychologist, Clinical (Licence: MI 6301015331) | |
| Enumeration Date | 2012-10-18 |
| Last Update Date | 2020-07-06 |