| NPI | 1841180213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PR 8336) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: PR 14590) |
| Enumeration Date | 2025-07-08 |
| Last Update Date | 2025-09-24 |