| NPI | 1982387031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WI 3957-57) |
| Additional Taxonomies | 103TF0200X Psychologist, Forensic (Licence: WI 3957-57) |
| Enumeration Date | 2023-08-07 |
| Last Update Date | 2023-08-07 |