| NPI | 1265733851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: GA PS-T001180) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: LA 1190) |
| Enumeration Date | 2010-11-12 |
| Last Update Date | 2025-12-15 |