| NPI | 1477200541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling |
| Additional Taxonomies | 103TH0004X Psychologist, Health |
| 103TH0100X Psychologist, Health Service | |
| 103TP2701X Psychologist, Group Psychotherapy | |
| Enumeration Date | 2022-03-08 |
| Last Update Date | 2022-03-08 |