| NPI | 1083754691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NC 3809) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: PA PS-005923-L) |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2026-06-23 |