| NPI | 1831393057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MT PSY-PSY-LIC-2980) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: KY 161603) |
| Enumeration Date | 2007-06-12 |
| Last Update Date | 2022-03-30 |