| NPI | 1750606299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MI 6361006617) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MI 6301013888) |
| Enumeration Date | 2010-03-27 |
| Last Update Date | 2022-03-02 |