| NPI | 1821377060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: SC 1493) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MD 05317) |
| 103T00000X Psychologist (Licence: DE B1-0001083) | |
| Enumeration Date | 2011-08-05 |
| Last Update Date | 2026-09-10 |