| NPI | 1710791470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TS0200X Psychologist, School (Licence: GA 461256) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: AZ 7786613) |
| Enumeration Date | 2025-02-04 |
| Last Update Date | 2025-02-04 |