| NPI | 1164658928 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NC 4281) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: TN p2941) |
| Enumeration Date | 2009-06-08 |
| Last Update Date | 2019-01-11 |