| NPI | 1225216880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CT 002904) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: VT 048-0000915) |
| Enumeration Date | 2008-02-06 |
| Last Update Date | 2024-12-09 |