| NPI | 1982395265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: AZ PSY-005341) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NV PY1040) |
| Enumeration Date | 2023-05-17 |
| Last Update Date | 2023-05-17 |