| NPI | 1316242340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: HI PSY 1216) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: HI 1216) |
| Enumeration Date | 2011-01-23 |
| Last Update Date | 2024-03-13 |