| NPI | 1033425731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TP0016X Psychologist, Prescribing (Medical) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: IA 001266) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: KS 1356) | |
| 103TC1900X Psychologist, Counseling | |
| 103TH0100X Psychologist, Health Service (Licence: IA 000579) | |
| Enumeration Date | 2010-08-19 |
| Last Update Date | 2022-03-08 |