| NPI | 1487691994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MO 2006000183) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MO 2006000183) |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2022-08-25 |