| NPI | 1194005660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NC 6364) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: AK 149234) |
| Enumeration Date | 2011-08-27 |
| Last Update Date | 2025-06-27 |