| NPI | 1780360644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PR 007425) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: PR 007425) |
| 103TS0200X Psychologist, School (Licence: PR 007425) | |
| Enumeration Date | 2023-06-26 |
| Last Update Date | 2023-06-26 |