| NPI | 1750895678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WI 5258) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA 29591) |
| Enumeration Date | 2017-11-30 |
| Last Update Date | 2025-02-18 |