| NPI | 1083273817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: UT 11299830-2501) |
| Additional Taxonomies | 103T00000X Psychologist |
| 103TH0100X Psychologist, Health Service | |
| Enumeration Date | 2019-06-05 |
| Last Update Date | 2019-06-18 |