| NPI | 1093576670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MT PSY-PSY-LIC-4593) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: UT 13014716-2501) |
| Enumeration Date | 2024-01-19 |
| Last Update Date | 2024-02-08 |