| NPI | 1831591031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WA PY60694009) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: IN 20042874A) |
| 106H00000X Marriage & Family Therapist (Licence: MO 2013037087) | |
| Enumeration Date | 2014-09-18 |
| Last Update Date | 2021-07-28 |