| NPI | 1457036691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VA 0810008179) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: DC PSY200001693) |
| Enumeration Date | 2023-06-15 |
| Last Update Date | 2025-12-06 |