| NPI | 1174954432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MS 54949) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: AL 1972) |
| Enumeration Date | 2013-12-11 |
| Last Update Date | 2015-12-03 |