| NPI | 1952500621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6301013909) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MI 6301011393) |
| Enumeration Date | 2007-07-13 |
| Last Update Date | 2024-05-15 |