| NPI | 1225408081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CO PSY.0006625) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: WA PSYC.PY.61366182) |
| Enumeration Date | 2015-10-05 |
| Last Update Date | 2026-03-12 |