| NPI | 1437381647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: HI 1367) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NC 5576) |
| Enumeration Date | 2009-08-20 |
| Last Update Date | 2026-03-05 |