| NPI | 1952414500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MO 2018018542) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: FL PY6334) |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2021-11-23 |