| NPI | 1740327733 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 103T00000X Psychologist (Licence: MD 1056) | 
| Additional Taxonomies | 103TF0000X Psychologist, Family (Licence: MD 1056) | 
| 103TP2701X Psychologist, Group Psychotherapy (Licence: MD 1056) | |
| Enumeration Date | 2007-01-31 | 
| Last Update Date | 2025-07-12 |