| NPI | 1861860884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MD 06606) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: KY 1767) |
| Enumeration Date | 2015-09-08 |
| Last Update Date | 2021-11-02 |