| NPI | 1639691124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY9902) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NJ 35SI00585700) |
| 103TC0700X Psychologist, Clinical (Licence: IN 20043231A) | |
| Enumeration Date | 2017-07-17 |
| Last Update Date | 2023-12-18 |