| NPI | 1144096165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MT PSY-PSY-LIC-5624) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: WA PSYC.PY.70013447) |
| Enumeration Date | 2023-11-30 |
| Last Update Date | 2026-03-26 |