| NPI | 1588180004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NV Py1044) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NV PY1044) |
| 103TF0200X Psychologist, Forensic (Licence: NV PY1044) | |
| Enumeration Date | 2017-08-16 |
| Last Update Date | 2023-08-08 |