| NPI | 1972859148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TH0100X Psychologist, Health Service (Licence: MA 10733) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MN 6971) |
| Enumeration Date | 2012-07-25 |
| Last Update Date | 2023-09-16 |