| NPI | 1447499124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: HI PSY-2070) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: VA 0810005402) |
| Enumeration Date | 2009-02-19 |
| Last Update Date | 2023-03-18 |