| NPI | 1972992469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: AZ 4528) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: AZ 4528) |
| Enumeration Date | 2015-01-21 |
| Last Update Date | 2025-03-26 |