| NPI | 1942418967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6301014519) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 017100) |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2022-08-05 |