| NPI | 1427648989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 103T00000X Psychologist |
| 103T00000X Psychologist | |
| 103T00000X Psychologist | |
| Enumeration Date | 2021-01-19 |
| Last Update Date | 2022-10-31 |