| NPI | 1801681457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MI 6351004870) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MI 6351004870) |
| Enumeration Date | 2025-04-14 |
| Last Update Date | 2026-06-08 |