| NPI | 1649588872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WI 3445-57) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: WI 3445-57) |
| Enumeration Date | 2010-09-22 |
| Last Update Date | 2022-11-03 |