| NPI | 1538148812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WI WI1281057) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: WI WI1281057) |
| Enumeration Date | 2006-01-13 |
| Last Update Date | 2024-02-01 |