| NPI | 1740419514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MA MA10824) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CT 002350) |
| 103TC0700X Psychologist Clinical (Licence: CT CT002350) | |
| Enumeration Date | 2009-07-14 |
| Last Update Date | 2023-03-28 |