| NPI | 1669070231 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MI 6361007714) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MI 6362009004) |
| Enumeration Date | 2020-10-15 |
| Last Update Date | 2023-08-27 |