| NPI | 1881006245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6301019141) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA 31127) |
| Enumeration Date | 2014-05-20 |
| Last Update Date | 2023-01-09 |