| NPI | 1922047596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TB0200X Psychologist Cognitive & Behavioral (Licence: OR 1610) |
| Additional Taxonomies | 103TB0200X Psychologist Cognitive & Behavioral (Licence: WA 400002990) |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2024-12-08 |