| NPI | 1902404122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MI 6361008075) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MI 6361008075) |
| Enumeration Date | 2020-10-09 |
| Last Update Date | 2024-10-11 |