| NPI | 1669859120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TH0100X Psychologist, Health Service (Licence: MA 10107) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: OR 3343) |
| Enumeration Date | 2015-05-04 |
| Last Update Date | 2023-11-30 |