| NPI | 1538728233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: AZ PSY-005785) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: WA PY60751048) |
| 103T00000X Psychologist (Licence: IA 113270) | |
| 103T00000X Psychologist (Licence: KS LP03025) | |
| 103T00000X Psychologist (Licence: FL PY9106) | |
| Enumeration Date | 2019-06-07 |
| Last Update Date | 2026-08-03 |