| NPI | 1346853454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: AZ PSY-004976) |
| Additional Taxonomies | 103TH0004X Psychologist, Health (Licence: AZ PSY-004976) |
| Enumeration Date | 2020-08-28 |
| Last Update Date | 2026-06-27 |