| NPI | 1780372284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WI 5037-57) |
| Additional Taxonomies | 103TB0200X Psychologist Cognitive & Behavioral (Licence: WI 5037-57) |
| 103TC0700X Psychologist Clinical (Licence: WI 5037-57) | |
| 103TH0004X Psychologist Health (Licence: WI 5037-57) | |
| Enumeration Date | 2023-04-24 |
| Last Update Date | 2023-05-19 |