| NPI | 1346870953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: TX 38128) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: OH 6634) |
| 103T00000X Psychologist (Licence: CA 16626) | |
| 103T00000X Psychologist (Licence: FL 6586) | |
| 103T00000X Psychologist (Licence: IN 20040723A) | |
| Enumeration Date | 2020-01-23 |
| Last Update Date | 2020-01-23 |