| NPI | 1760104897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WI 5001-57) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: WI 5001-57) |
| Enumeration Date | 2022-09-15 |
| Last Update Date | 2023-05-30 |