| NPI | 1861868499 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6301019084) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: WA PY60740273) |
| Enumeration Date | 2015-08-18 |
| Last Update Date | 2022-07-25 |