| NPI | 1902176324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: FL 11647) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: PR 4096) |
| Enumeration Date | 2012-01-02 |
| Last Update Date | 2024-07-05 |