| NPI | 1720956352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PR 7217) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: PR 7217) |
| Enumeration Date | 2025-10-27 |
| Last Update Date | 2025-10-27 |