| NPI | 1578111407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NC 6726) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: FL PY10565) |
| Enumeration Date | 2019-09-04 |
| Last Update Date | 2026-05-10 |