| NPI | 1013025972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: SC 693) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: TX 38479) |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2022-12-27 |