| NPI | 1619547585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TS0200X Psychologist, School (Licence: MI SP0000001035969) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MI 6362009321) |
| Enumeration Date | 2021-07-01 |
| Last Update Date | 2021-07-01 |