| NPI | 1225310345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: SD 608) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: WY 579) |
| 103TC0700X Psychologist, Clinical (Licence: ND 568) | |
| Enumeration Date | 2011-09-14 |
| Last Update Date | 2020-09-15 |