| NPI | 1033617063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MO 01803) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MO 01803) |
| Enumeration Date | 2018-01-24 |
| Last Update Date | 2018-05-14 |