| NPI | 1144897265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: AZ PSY.005436) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: AZ PSY-005436) |
| Enumeration Date | 2021-06-08 |
| Last Update Date | 2022-01-25 |