| NPI | 1851917843 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VA 0810006835) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: TN 4257) |
| Enumeration Date | 2020-06-25 |
| Last Update Date | 2026-07-02 |