| NPI | 1508741109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MS 36-626) |
| Enumeration Date | 2025-08-11 |
| Last Update Date | 2025-08-11 |