| NPI | 1962859710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: KS 2696) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MO 2025040314) |
| Enumeration Date | 2016-05-23 |
| Last Update Date | 2026-07-28 |