| NPI | 1083714620 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: AL 607) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: NM PSY1602) |
| Enumeration Date | 2006-09-24 |
| Last Update Date | 2020-06-04 |