| NPI | 1710403266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TH0004X Psychologist, Health (Licence: AZ PSY-005044) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: AZ Psy-005044) |
| 103TC0700X Psychologist, Clinical (Licence: CO 0004648) | |
| 103TC0700X Psychologist, Clinical (Licence: AZ PSY-005044) | |
| 103TH0004X Psychologist, Health (Licence: CO 0004648) | |
| Enumeration Date | 2017-08-16 |
| Last Update Date | 2021-06-21 |