| NPI | 1366932956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TS0200X Psychologist, School |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NV PY1306) |
| Enumeration Date | 2018-05-18 |
| Last Update Date | 2025-12-23 |