| NPI | 1932811163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: ID psy202707) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: UT 56668202501) |
| Enumeration Date | 2022-12-19 |
| Last Update Date | 2024-04-17 |