| NPI | 1053808246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: GA 006389) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CT 9039) |
| 103T00000X Psychologist (Licence: FL 1866) | |
| Enumeration Date | 2018-04-13 |
| Last Update Date | 2025-12-05 |