| NPI | 1851058929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VA 0810007694) |
| Additional Taxonomies | 103TH0100X Psychologist, Health Service |
| Enumeration Date | 2021-11-23 |
| Last Update Date | 2023-11-08 |