| NPI | 1932226826 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: OR 2684) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: PA PSO17610) |
| 103T00000X Psychologist (Licence: NE 867) | |
| 103TC0700X Psychologist, Clinical (Licence: NE 867) | |
| Enumeration Date | 2007-03-23 |
| Last Update Date | 2023-12-05 |