| NPI | 1275152464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PA PS019173) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: PA BH003040) |
| Enumeration Date | 2020-04-09 |
| Last Update Date | 2026-04-02 |