| NPI | 1912478108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TN 3590) |
| Additional Taxonomies | 103TA0700X Psychologist, Adult Development & Aging (Licence: TN 3590) |
| 103TF0200X Psychologist, Forensic (Licence: TN 3590) | |
| Enumeration Date | 2018-12-16 |
| Last Update Date | 2019-09-09 |