| NPI | 1144285198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: AR 14-11P) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: AZ 1452) |
| Enumeration Date | 2006-04-20 |
| Last Update Date | 2017-01-12 |