| NPI | 1124001730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MA 7061) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MA 7061) |
| Enumeration Date | 2005-11-29 |
| Last Update Date | 2022-12-05 |