| NPI | 1598426884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TP2701X Psychologist, Group Psychotherapy (Licence: MO 2021011992) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: MO 2021011992) |
| 103TC0700X Psychologist, Clinical (Licence: MO 2021011992) | |
| Enumeration Date | 2022-01-07 |
| Last Update Date | 2025-09-29 |