| NPI | 1952855058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: FL 11148) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: FL PsyPact.9853) |
| 103T00000X Psychologist (Licence: CO PSY.0005601) | |
| Enumeration Date | 2016-08-08 |
| Last Update Date | 2023-07-12 |