| NPI | 1285402586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling |
| 103TH0100X Psychologist, Health Service | |
| Enumeration Date | 2023-12-15 |
| Last Update Date | 2023-12-15 |