| NPI | 1205843265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NM 732) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: NM 732) |
| 103TC2200X Psychologist Clinical Child & Adolescent | |
| 103TR0400X Psychologist Rehabilitation (Licence: NM 732) | |
| Enumeration Date | 2006-08-02 |
| Last Update Date | 2022-10-06 |