| NPI | 1891990438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MI 6301013917) |
| Additional Taxonomies | 103TC1900X Psychologist Counseling (Licence: MI 6301013917) |
| Enumeration Date | 2007-06-15 |
| Last Update Date | 2023-10-20 |