| NPI | 1205186178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: DC 1000660) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: VA 0810006729) |
| 103TC0700X Psychologist, Clinical (Licence: MD 06560) | |
| Enumeration Date | 2012-09-18 |
| Last Update Date | 2025-09-03 |