| NPI | 1023088424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OH p.5834) |
| Additional Taxonomies | 103TH0100X Psychologist, Health Service (Licence: OH 5843) |
| Enumeration Date | 2006-01-26 |
| Last Update Date | 2024-09-24 |