| NPI | 1528387057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: GA PSY004089) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NC 3932) |
| Enumeration Date | 2010-05-24 |
| Last Update Date | 2022-03-07 |