| NPI | 1770396442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: WI 5292-57) |
| Additional Taxonomies | 103TB0200X Psychologist Cognitive & Behavioral |
| 103TP2701X Psychologist Group Psychotherapy | |
| Enumeration Date | 2025-01-28 |
| Last Update Date | 2025-07-31 |