| NPI | 1093327140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OR 3429) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: UT 11453705-2501) |
| Enumeration Date | 2020-08-19 |
| Last Update Date | 2023-04-24 |