| NPI | 1487342358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PR 7570) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: PR 7570) |
| 103TS0200X Psychologist, School (Licence: PR 7570) | |
| Enumeration Date | 2023-04-27 |
| Last Update Date | 2024-10-15 |