| NPI | 1295958387 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OK 1488) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: GA PSY002716) |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2025-07-17 |