| NPI | 1922771708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: IA 107800) |
| Additional Taxonomies | 103TP2701X Psychologist, Group Psychotherapy (Licence: IA 107800) |
| Enumeration Date | 2021-07-28 |
| Last Update Date | 2021-07-28 |