| NPI | 1831872704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: FL PY11904) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: IL 071.011243) |
| Enumeration Date | 2023-08-08 |
| Last Update Date | 2024-09-10 |