| NPI | 1639297344 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: VT 048.0135139) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: UT 5729247-2501) |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2025-06-07 |