| NPI | 1942305917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TF0200X Psychologist, Forensic (Licence: MI 6301002047) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: MI 6301002047) |
| 103TC0700X Psychologist, Clinical (Licence: MI 6301002047) | |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2025-09-11 |