| NPI | 1851549539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MA 11127) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NH 1274) |
| Enumeration Date | 2008-09-05 |
| Last Update Date | 2019-10-03 |