| NPI | 1326396862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MD 04538) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: DC 1000497) |
| 103TC0700X Psychologist, Clinical (Licence: FL 12193) | |
| Enumeration Date | 2012-08-15 |
| Last Update Date | 2025-01-07 |