| NPI | 1659188498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TH0100X Psychologist, Health Service |
| Additional Taxonomies | 103T00000X Psychologist (Licence: S545-520-79-372-0) |
| Enumeration Date | 2024-12-16 |
| Last Update Date | 2024-12-18 |