| NPI | 1922256809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OR 2871) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NV PY0624) |
| Enumeration Date | 2008-09-03 |
| Last Update Date | 2024-04-02 |