| NPI | 1205859394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PA PS005689L) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: AZ PSY-005747) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2024-11-25 |