| NPI | 1679236137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WI 3994-57) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: WI 3994-57) |
| Enumeration Date | 2021-10-20 |
| Last Update Date | 2024-01-12 |