| NPI | 1083070536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: VA 0810005353) |
| Additional Taxonomies | 103TH0004X Psychologist, Health (Licence: VA 0810005353) |
| Enumeration Date | 2016-01-13 |
| Last Update Date | 2021-07-26 |