| NPI | 1033795422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PA PS020572) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: DC PSY2000033) |
| 103TC0700X Psychologist, Clinical (Licence: NY 024806) | |
| 103TC0700X Psychologist, Clinical (Licence: MD 06526) | |
| 103TC0700X Psychologist, Clinical (Licence: VA 0810007395) | |
| Enumeration Date | 2021-03-24 |
| Last Update Date | 2026-03-13 |