| NPI | 1801876545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MS 53935) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: VA 0810002934) |
| Enumeration Date | 2006-01-19 |
| Last Update Date | 2016-07-05 |