| NPI | 1003979477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: HI PSY-2088-0) |
| Additional Taxonomies | 103TF0000X Psychologist, Family |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2023-06-16 |