| NPI | 1437869153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PR 7537) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: PR 7537) |
| Enumeration Date | 2022-12-05 |
| Last Update Date | 2025-07-09 |