| NPI | 1154660843 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MO 2013004423) |
| Additional Taxonomies | 103TF0200X Psychologist Forensic (Licence: TX 35200) |
| 103TF0200X Psychologist Forensic (Licence: MO 2013004423) | |
| 103TH0004X Psychologist Health (Licence: MO 2013004423) | |
| Enumeration Date | 2013-01-31 |
| Last Update Date | 2013-08-23 |