| NPI | 1194880286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WI 2752-57) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MI 6301013947) |
| Enumeration Date | 2006-12-27 |
| Last Update Date | 2025-09-24 |