| NPI | 1104295096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA 32397) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 024543) |
| 103TC0700X Psychologist, Clinical (Licence: DE B1-0011277) | |
| Enumeration Date | 2015-09-21 |
| Last Update Date | 2023-07-14 |