| NPI | 1639262207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MD 01919) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: VA 0810003032) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2023-05-25 |