| NPI | 1578606174 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: AL 1399) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: AL 1399) |
| 103TC0700X Psychologist, Clinical (Licence: AL 1399) | |
| Enumeration Date | 2007-02-14 |
| Last Update Date | 2019-07-03 |