| NPI | 1639728405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6361007649) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MI 6362005361) |
| 103TC0700X Psychologist, Clinical (Licence: MI 6301018082) | |
| Enumeration Date | 2019-09-05 |
| Last Update Date | 2021-10-06 |