| NPI | 1699291963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: SC 1801) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: KS 2800) |
| 103TR0400X Psychologist Rehabilitation (Licence: GA PSY004457) | |
| Enumeration Date | 2017-08-18 |
| Last Update Date | 2023-11-01 |