| NPI | 1285512897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TS0200X Psychologist, School (Licence: PR 6629666) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral |
| 103TF0000X Psychologist, Family | |
| 103T00000X Psychologist | |
| 103TH0100X Psychologist, Health Service | |
| Enumeration Date | 2025-08-22 |
| Last Update Date | 2025-08-22 |