| NPI | 1225392103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MA 10900-PY-PR) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 103TH0004X Psychologist, Health (Licence: MA 10900-PY-PR) | |
| Enumeration Date | 2012-06-26 |
| Last Update Date | 2020-10-28 |