| NPI | 1578002234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: FL SS1410) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: FL SS1410) |
| 247200000X Technician, Other | |
| Enumeration Date | 2017-02-14 |
| Last Update Date | 2025-01-28 |