| NPI | 1952003691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: MA PSY5000482) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MA PSY5000482) |
| Enumeration Date | 2023-03-20 |
| Last Update Date | 2023-03-20 |