| NPI | 1679125140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: MS 601053) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: AL 2139) |
| Enumeration Date | 2019-07-15 |
| Last Update Date | 2020-08-27 |