| NPI | 1821603283 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MI 6301018963) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MI 6351004265) |
| Enumeration Date | 2020-09-12 |
| Last Update Date | 2022-06-09 |