| NPI | 1336122704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MO PY01685) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MO SW002855) |
| Enumeration Date | 2005-11-21 |
| Last Update Date | 2025-01-22 |