| NPI | 1891122180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MA 11054) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MA 11054) |
| Enumeration Date | 2013-10-01 |
| Last Update Date | 2024-04-30 |