| NPI | 1700503281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PR 7258) |
| Additional Taxonomies | 103TH0100X Psychologist Health Service (Licence: PR 7258) |
| Enumeration Date | 2022-10-25 |
| Last Update Date | 2022-10-25 |