| NPI | 1154949923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: NV PY0973) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: NE 1002) |
| Enumeration Date | 2020-07-08 |
| Last Update Date | 2020-09-17 |