| NPI | 1225104177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WV 640) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: WI 2503-057) |
| Enumeration Date | 2006-11-24 |
| Last Update Date | 2020-04-15 |