| NPI | 1558412296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MA 4355) |
| Additional Taxonomies | 103TF0200X Psychologist, Forensic (Licence: MA 4355) |
| 103T00000X Psychologist (Licence: MA 4355) | |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2025-09-11 |