| NPI | 1366166738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VA 0810008377) |
| Additional Taxonomies | 103TH0100X Psychologist, Health Service (Licence: VA 0810008377) |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: VA 0810008377) | |
| Enumeration Date | 2022-09-29 |
| Last Update Date | 2026-08-18 |