| NPI | 1720453640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TH0004X Psychologist, Health (Licence: HI 1635) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MD 05667) |
| Enumeration Date | 2015-12-03 |
| Last Update Date | 2022-07-21 |