| NPI | 1184305534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CT 4619) |
| Additional Taxonomies | 103TF0200X Psychologist, Forensic |
| Enumeration Date | 2023-07-28 |
| Last Update Date | 2025-03-19 |