| NPI | 1801501952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MO 2025035648) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: KS LP03468) |
| Enumeration Date | 2023-01-23 |
| Last Update Date | 2025-09-18 |