| NPI | 1891046447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY11000) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MI 6301013971) |
| Enumeration Date | 2012-09-23 |
| Last Update Date | 2021-04-06 |