| NPI | 1336613827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: FL PY12155) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: PR 204) |
| Enumeration Date | 2019-01-17 |
| Last Update Date | 2024-05-17 |