| NPI | 1891482949 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: HI PSY--2065-0) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CO PSY.0005951) |
| Enumeration Date | 2023-04-19 |
| Last Update Date | 2023-04-19 |