| NPI | 1770651283 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MI 6361006349) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MI 6301012963) |
| Enumeration Date | 2006-12-01 |
| Last Update Date | 2024-03-28 |