| NPI | 1790872034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: MI 6361004266) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MI 6301005471) |
| Enumeration Date | 2006-10-06 |
| Last Update Date | 2024-03-22 |