| NPI | 1912329970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CA 33813) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: MI 6301019417) |
| 103TS0200X Psychologist School (Licence: CA 2893) | |
| Enumeration Date | 2014-01-10 |
| Last Update Date | 2025-07-08 |