| NPI | 1780820886 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: FL PY11760) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MI 6301010699) |
| Enumeration Date | 2008-12-20 |
| Last Update Date | 2023-03-07 |