| NPI | 1710469762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: DC PSY1001532) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MD 06175) |
| 103T00000X Psychologist (Licence: MI 6301017550) | |
| Enumeration Date | 2018-09-05 |
| Last Update Date | 2020-05-05 |