| NPI | 1699244509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OR 3354) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: HI PSY-1825) |
| Enumeration Date | 2018-11-20 |
| Last Update Date | 2025-10-14 |