| NPI | 1417152281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: IL 071.008870) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CO PSY.0004851) |
| 103T00000X Psychologist (Licence: TX 36777) | |
| 103TC0700X Psychologist, Clinical (Licence: UT 11379246-2501) | |
| 103TC0700X Psychologist, Clinical (Licence: WA PY61012327) | |
| Enumeration Date | 2007-06-20 |
| Last Update Date | 2023-07-15 |