| NPI | 1043387798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TH0100X Psychologist, Health Service (Licence: IA 00119) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: IA 00424) |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2025-09-11 |