| NPI | 1922729474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: AZ PSY-005508) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: PR 006781) |
| Enumeration Date | 2022-09-02 |
| Last Update Date | 2022-09-02 |