| NPI | 1568525202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: GA 1835) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: GA 001835) |
| Enumeration Date | 2006-12-17 |
| Last Update Date | 2022-05-06 |