| NPI | 1518946193 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: AZ PSY-005206) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: SD 375) |
| Enumeration Date | 2006-01-12 |
| Last Update Date | 2024-01-24 |