| NPI | 1295570794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: WA PY61498374) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: ME PS2551) |
| Enumeration Date | 2024-06-26 |
| Last Update Date | 2024-06-26 |