| NPI | 1235784810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NM psy1560) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NM 1560) |
| Enumeration Date | 2019-08-09 |
| Last Update Date | 2025-09-17 |