| NPI | 1992515779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6301019648) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: TX 40182) |
| Enumeration Date | 2025-01-13 |
| Last Update Date | 2025-09-06 |