| NPI | 1013674860 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: TN 3780) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: TN 3780) |
| Enumeration Date | 2021-11-29 |
| Last Update Date | 2025-09-08 |