| NPI | 1881146728 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: AZ 005574) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: PR 5647) |
| Enumeration Date | 2016-10-26 |
| Last Update Date | 2023-09-19 |