| NPI | 1467599456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: NM 1032) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: MD 01756) |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2024-10-13 |