| NPI | 1023338423 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: AZ PSY-004622) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: PA PS016730) |
| Enumeration Date | 2010-06-08 |
| Last Update Date | 2019-04-16 |