| NPI | 1215762752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TH0100X Psychologist, Health Service (Licence: NC 4029) |
| Additional Taxonomies | 103TH0100X Psychologist, Health Service (Licence: TN 3973) |
| Enumeration Date | 2024-09-04 |
| Last Update Date | 2024-09-04 |