| NPI | 1487856977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: UT 94-266379-2501) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: HI 1483) |
| 103TC0700X Psychologist, Clinical (Licence: KS 2025) | |
| 103T00000X Psychologist (Licence: AZ 3226) | |
| Enumeration Date | 2007-06-05 |
| Last Update Date | 2024-09-11 |