| NPI | 1013634286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NV PY1244) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: UT 14149490-2501) |
| 103T00000X Psychologist (Licence: TN 3930) | |
| Enumeration Date | 2022-10-27 |
| Last Update Date | 2026-03-10 |