| NPI | 1376078402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NC 5210) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NC 5210) |
| Enumeration Date | 2017-04-26 |
| Last Update Date | 2020-05-21 |