| NPI | 1801316690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MO 2019007767) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MI 6301016948) |
| Enumeration Date | 2017-06-22 |
| Last Update Date | 2022-07-21 |