| NPI | 1699059493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: DC PSY1000719) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: DC 1000719) |
| Enumeration Date | 2011-09-28 |
| Last Update Date | 2025-02-25 |