| NPI | 1891158432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IA 122027) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: IA 0051) |
| 103TC0700X Psychologist, Clinical (Licence: HI PSY-2336) | |
| Enumeration Date | 2016-03-31 |
| Last Update Date | 2026-07-29 |