| NPI | 1851993786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: AZ 5308) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: AZ 5308) |
| 103TC0700X Psychologist, Clinical (Licence: AZ 5308) | |
| 103TH0004X Psychologist, Health (Licence: AZ 5308) | |
| Enumeration Date | 2020-11-16 |
| Last Update Date | 2020-11-16 |