| NPI | 1942794920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: AZ PSY-004974) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: AZ PSY-004974) |
| Enumeration Date | 2018-06-21 |
| Last Update Date | 2025-08-06 |