| NPI | 1790836351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NE 304) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NE 304) |
| Enumeration Date | 2007-01-12 |
| Last Update Date | 2022-07-21 |