| NPI | 1831803014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PA PS019861) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MI 6301019238) |
| Enumeration Date | 2023-01-11 |
| Last Update Date | 2024-06-03 |