| NPI | 1952461477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MA 6646) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CT 003756) |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2026-07-13 |