| NPI | 1588119168 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6301017632) |
| Additional Taxonomies | 103TR0400X Psychologist, Rehabilitation (Licence: MI 6301017632) |
| Enumeration Date | 2016-08-24 |
| Last Update Date | 2019-01-10 |