| NPI | 1235891052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MN 3039) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MS 3039) |
| Enumeration Date | 2021-10-08 |
| Last Update Date | 2021-10-11 |