| NPI | 1992420848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY12050) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: TX 40684) |
| Enumeration Date | 2022-10-04 |
| Last Update Date | 2025-10-22 |