| NPI | 1811133457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TF0200X Psychologist, Forensic (Licence: NC 4716) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: VA 0810005217) |
| 103T00000X Psychologist (Licence: SC 1075) | |
| 103T00000X Psychologist (Licence: GA 3072) | |
| Enumeration Date | 2009-01-04 |
| Last Update Date | 2024-12-20 |