| NPI | 1033073739 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TP2701X Psychologist, Group Psychotherapy (Licence: WI 546457) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WI 16750930) |
| Enumeration Date | 2025-12-16 |
| Last Update Date | 2026-05-01 |