| NPI | 1013386937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: OR 2555) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: OR 2555) |
| 103TH0004X Psychologist, Health (Licence: OR 2555) | |
| Enumeration Date | 2015-09-21 |
| Last Update Date | 2015-09-21 |