| NPI | 1649886474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6361007982) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MI 6362009211) |
| Enumeration Date | 2020-09-17 |
| Last Update Date | 2024-02-08 |