| NPI | 1609658624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WI 5210-57) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: WI 5210-57) |
| 103TC0700X Psychologist, Clinical (Licence: IA 117530) | |
| Enumeration Date | 2023-10-16 |
| Last Update Date | 2024-11-05 |