| NPI | 1932545381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MA 9635) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral |
| Enumeration Date | 2013-05-13 |
| Last Update Date | 2024-06-16 |