| NPI | 1336224989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WI 2724-57) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WI 7902-33) |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2022-11-30 |