| NPI | 1225068331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NC 6153) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: FL PY0005438) |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2023-01-26 |