| NPI | 1285883223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: OR 2347) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: OR 2347) |
| Enumeration Date | 2008-09-15 |
| Last Update Date | 2024-11-11 |