| NPI | 1174245732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: PA PS020328) |
| Additional Taxonomies | 103T00000X Psychologist |
| 103TB0200X Psychologist, Cognitive & Behavioral | |
| Enumeration Date | 2022-09-12 |
| Last Update Date | 2025-07-15 |