| NPI | 1407946999 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: AR 99-5P) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: OK 1336) |
| 103TC0700X Psychologist, Clinical (Licence: AR 99-5P) | |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2023-03-07 |