| NPI | 1376600502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: HI PSY - 610) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: HI PSY-610) |
| Enumeration Date | 2007-01-03 |
| Last Update Date | 2024-06-17 |