| NPI | 1962188110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6301019237) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: WI 4098-57) |
| Enumeration Date | 2023-06-23 |
| Last Update Date | 2023-07-26 |