| NPI | 1942799911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: NH 625) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: MA 6345) |
| Enumeration Date | 2018-05-06 |
| Last Update Date | 2020-04-09 |