| NPI | 1851323984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: IA 00778) |
| Additional Taxonomies | 103TH0100X Psychologist, Health Service (Licence: IA 00396) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2026-07-16 |