| NPI | 1780818021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MI 6361007089) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MI 6301009502) |
| Enumeration Date | 2009-05-14 |
| Last Update Date | 2024-03-28 |