| NPI | 1912933086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NC 4211) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NC 4211) |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2019-12-11 |