| NPI | 1306514559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PR 7087) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: PR 7087) |
| Enumeration Date | 2021-09-02 |
| Last Update Date | 2025-02-13 |