| NPI | 1205149481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: GA PSY003584) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: GA PSY003584) |
| Enumeration Date | 2010-07-16 |
| Last Update Date | 2020-02-11 |