| NPI | 1770108284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 103TC1900X Psychologist Counseling |
| 103TC2200X Psychologist Clinical Child & Adolescent | |
| Enumeration Date | 2020-06-10 |
| Last Update Date | 2023-09-26 |