| NPI | 1417202011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TN 4023) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: LA 1691) |
| Enumeration Date | 2012-07-19 |
| Last Update Date | 2024-02-07 |