| NPI | 1508830910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: AL 330) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: FL PY10113) |
| Enumeration Date | 2006-02-14 |
| Last Update Date | 2023-03-08 |