| NPI | 1154873958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: WI 5245-57) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: WI 2862) |
| 103T00000X Psychologist (Licence: WI 5155-57) | |
| Enumeration Date | 2016-10-27 |
| Last Update Date | 2024-10-02 |