| NPI | 1518548460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VA 0810008657) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CT 5247) |
| Enumeration Date | 2021-04-20 |
| Last Update Date | 2025-11-04 |