| NPI | 1649949421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: PA PS019356) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: PA PS019356) |
| Enumeration Date | 2021-09-07 |
| Last Update Date | 2025-07-26 |