| NPI | 1013436567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: OR 3027) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: FL PY9989) |
| Enumeration Date | 2017-09-15 |
| Last Update Date | 2025-08-18 |