| NPI | 1386084036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: DC 1001617) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: TX 38037) |
| 103TC0700X Psychologist, Clinical (Licence: TX 38037) | |
| Enumeration Date | 2013-06-26 |
| Last Update Date | 2020-08-20 |