| NPI | 1073332128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: IA 122110) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: IA 122110) |
| Enumeration Date | 2024-10-07 |
| Last Update Date | 2024-10-07 |