| NPI | 1134633498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: AZ PSY-004977) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: NM 1485) |
| Enumeration Date | 2017-11-24 |
| Last Update Date | 2023-05-09 |