| NPI | 1043082142 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: PR 7063) | 
| Additional Taxonomies | 103T00000X Psychologist (Licence: PR 7063) | 
| Enumeration Date | 2023-10-23 | 
| Last Update Date | 2025-05-12 |