| NPI | 1205825544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NC 2457) |
| Additional Taxonomies | 103TH0004X Psychologist, Health (Licence: NC 2457) |
| Enumeration Date | 2005-10-19 |
| Last Update Date | 2022-12-05 |