| NPI | 1669045076 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MD 06818) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: DC 200001369) |
| Enumeration Date | 2021-07-22 |
| Last Update Date | 2026-06-29 |