| NPI | 1679086102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: PA ps018723) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: DE B1-0001180) |
| Enumeration Date | 2017-11-06 |
| Last Update Date | 2024-05-22 |