| NPI | 1194497354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: LA 1588) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: FL PY-11023) |
| Enumeration Date | 2021-10-05 |
| Last Update Date | 2025-05-16 |