| NPI | 1902579394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OR 3611) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MI 6351004389) |
| 103TC0700X Psychologist, Clinical (Licence: MI 6351004389APP21) | |
| Enumeration Date | 2021-07-30 |
| Last Update Date | 2023-06-07 |