| NPI | 1548350861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: RI 353) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MA 4412) |
| Enumeration Date | 2006-10-15 |
| Last Update Date | 2023-12-19 |