| NPI | 1033669080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MO 2016032320) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: FL PY5269) |
| Enumeration Date | 2016-10-13 |
| Last Update Date | 2019-09-27 |