| NPI | 1548976913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: HI PSY2075) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CO PSY.0006047) |
| Enumeration Date | 2023-01-27 |
| Last Update Date | 2024-06-19 |