| NPI | 1962978908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MI 6301017288) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MI 6301017288) |
| 103TH0004X Psychologist Health (Licence: MI 6301017288) | |
| Enumeration Date | 2018-10-17 |
| Last Update Date | 2025-06-30 |