| NPI | 1649151929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NC 6982) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NC 103677) |
| Enumeration Date | 2025-09-11 |
| Last Update Date | 2026-03-17 |