| NPI | 1972146363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6362005151) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MI 6301018170) |
| Enumeration Date | 2019-10-18 |
| Last Update Date | 2020-05-26 |