| NPI | 1790402568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6301019128) |
| Additional Taxonomies | 103TH0004X Psychologist, Health |
| Enumeration Date | 2022-10-24 |
| Last Update Date | 2023-01-30 |