| NPI | 1609792589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NC 6828) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CO 3809) |
| Enumeration Date | 2026-06-25 |
| Last Update Date | 2026-06-25 |