| NPI | 1730129883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NH 1260) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: UT 4923236-2501) |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2025-08-19 |