| NPI | 1386398030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VA 0810007826) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: DC 20001418) |
| 103TC0700X Psychologist, Clinical (Licence: MD 06779) | |
| Enumeration Date | 2022-02-10 |
| Last Update Date | 2025-04-07 |