| NPI | 1306386917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: FL PY10815) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: TN 3278) |
| Enumeration Date | 2017-03-01 |
| Last Update Date | 2023-07-11 |