| NPI | 1043995376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: TX 37615) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: WI 5068-57) |
| Enumeration Date | 2023-06-15 |
| Last Update Date | 2023-06-15 |