| NPI | 1639564032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: OH 7561) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MI 6301015977) |
| Enumeration Date | 2015-04-02 |
| Last Update Date | 2022-07-21 |