| NPI | 1780274647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: ND 630) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MD 06926) |
| 103TC0700X Psychologist, Clinical (Licence: MD 06926) | |
| 103TC0700X Psychologist, Clinical (Licence: ND 630) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MD 06926) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: ND 630) | |
| Enumeration Date | 2021-01-24 |
| Last Update Date | 2022-10-21 |