| NPI | 1386737450 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CT CT001405) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CT 1405CT01) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2023-11-21 |