| NPI | 1508989146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MO 2000159801) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: KS LP 1095) |
| Enumeration Date | 2007-04-09 |
| Last Update Date | 2021-08-05 |