| NPI | 1679357032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MI 6361008105) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MI 6361008105) |
| Enumeration Date | 2023-08-24 |
| Last Update Date | 2026-03-23 |