| NPI | 1730563115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OR 3441) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: AZ 4465) |
| Enumeration Date | 2015-07-15 |
| Last Update Date | 2022-11-06 |