| NPI | 1134100712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TN p 1201) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MS 32483) |
| Enumeration Date | 2005-11-09 |
| Last Update Date | 2022-08-01 |