| NPI | 1003865569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IA 110366) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: WI 2568-057) |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2023-01-17 |