| NPI | 1669480091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: ID PSY-203086) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: KS 2171) |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2021-01-08 |