| NPI | 1437284007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PA 006087-L) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: PA PS006087-L) |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2025-04-30 |