| NPI | 1699033506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: AZ 4259) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: AZ PSY-004259) |
| Enumeration Date | 2012-04-27 |
| Last Update Date | 2025-10-29 |