| NPI | 1972812113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TX 40068) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: FL PY8171) |
| Enumeration Date | 2010-10-06 |
| Last Update Date | 2024-09-25 |