| NPI | 1174085278 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MA 11160) |
| Additional Taxonomies | 103TA0700X Psychologist, Adult Development & Aging (Licence: MA 11160) |
| Enumeration Date | 2019-04-05 |
| Last Update Date | 2021-02-09 |