| NPI | 1205328390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY10498) |
| Additional Taxonomies | 103T00000X Psychologist |
| 103TC0700X Psychologist, Clinical (Licence: AZ PSY-005031) | |
| Enumeration Date | 2018-06-04 |
| Last Update Date | 2022-10-12 |