| NPI | 1376062133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MA PSY10000099) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CO PSY.0006989) |
| Enumeration Date | 2017-09-13 |
| Last Update Date | 2026-03-24 |