| NPI | 1891158978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6301017802) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MI 6301017611) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-04-05 |
| Last Update Date | 2019-03-01 |