| NPI | 1780456244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MI 6361006494) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: MI 6361006494) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MI 6361006494) | |
| Enumeration Date | 2023-10-26 |
| Last Update Date | 2023-10-26 |