| NPI | 1124033824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: GA PSY004752) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NC 3306) |
| 103TC0700X Psychologist, Clinical (Licence: VA 0810002866) | |
| Enumeration Date | 2006-07-30 |
| Last Update Date | 2024-01-29 |