| NPI | 1760431415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: OR 1748) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: OR 1748) |
| Enumeration Date | 2006-05-09 |
| Last Update Date | 2026-01-08 |