| NPI | 1710032685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6301011362) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: WA PY00003793) |
| Enumeration Date | 2007-01-24 |
| Last Update Date | 2022-08-14 |