| NPI | 1235179078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: AL 2396) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: GA PSY003597) |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2025-04-25 |