| NPI | 1205086766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MA 10995) |
| Additional Taxonomies | 103T00000X Psychologist |
| 103TH0100X Psychologist, Health Service | |
| Enumeration Date | 2008-09-22 |
| Last Update Date | 2025-05-02 |