| NPI | 1184281438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: UT 12931159-2501) |
| Additional Taxonomies | 103T00000X Psychologist |
| Enumeration Date | 2019-05-22 |
| Last Update Date | 2022-09-12 |