| NPI | 1497042337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: AZ PSY-004503) |
| Additional Taxonomies | 103TC1900X Psychologist Counseling (Licence: AZ PSY-004503) |
| 103TF0000X Psychologist Family (Licence: AZ PSY-004503) | |
| 103TF0200X Psychologist Forensic (Licence: AZ PSY-004503) | |
| Enumeration Date | 2011-06-29 |
| Last Update Date | 2021-09-13 |