| NPI | 1205480217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: SC 1911) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: SC 1911) |
| 103T00000X Psychologist (Licence: GA PSY004605) | |
| Enumeration Date | 2019-07-29 |
| Last Update Date | 2026-07-02 |