| NPI | 1114749249 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WI 5251-57) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: WI 5251-57) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: WI 5251-57) | |
| Enumeration Date | 2024-10-29 |
| Last Update Date | 2024-10-29 |