| NPI | 1649562869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MI 6361004274) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MI 6301014598) |
| Enumeration Date | 2011-05-05 |
| Last Update Date | 2022-08-04 |