| NPI | 1316476328 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MD 07056) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: DC PSY200001555) |
| 103TC0700X Psychologist, Clinical (Licence: CA PSY28977) | |
| Enumeration Date | 2017-06-05 |
| Last Update Date | 2025-04-04 |