| NPI | 1821344151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: AR 04-19P) |
| Additional Taxonomies | 174400000X Specialist (Licence: AR 04-19P) |
| Enumeration Date | 2012-07-24 |
| Last Update Date | 2025-11-03 |