| NPI | 1922197904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MA 7307) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: AZ 4058) |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2020-01-16 |