| NPI | 1588284665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NC 5767) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NC 103375) |
| Enumeration Date | 2020-04-20 |
| Last Update Date | 2025-07-09 |