| NPI | 1366280067 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TF0000X Psychologist, Family |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 103TP0016X Psychologist, Prescribing (Medical) | |
| 103TR0400X Psychologist, Rehabilitation | |
| Enumeration Date | 2024-07-17 |
| Last Update Date | 2024-07-17 |