| NPI | 1740999515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NC 6066) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: PA PS019417) |
| Enumeration Date | 2022-11-21 |
| Last Update Date | 2022-11-21 |