| NPI | 1699734012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TP0814X Psychologist, Psychoanalysis |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling |
| 207P00000X Emergency Medicine (Licence: MI 4301045596) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MI 4301045596) | |
| Enumeration Date | 2006-03-23 |
| Last Update Date | 2023-06-14 |