| NPI | 1518748797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PR 7682) |
| Additional Taxonomies | 103TF0200X Psychologist, Forensic |
| Enumeration Date | 2023-10-12 |
| Last Update Date | 2025-08-26 |