| NPI | 1710503776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: UT 14226885-2501) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: WA PY61476622) |
| Enumeration Date | 2020-06-24 |
| Last Update Date | 2025-12-12 |