| NPI | 1235651290 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral |
| 103TC0700X Psychologist, Clinical (Licence: MA 11006) | |
| Enumeration Date | 2017-07-12 |
| Last Update Date | 2021-06-05 |