| NPI | 1255385159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CO 4136) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: KS 1210) |
| 103TC0700X Psychologist, Clinical (Licence: ID PSY-202399) | |
| Enumeration Date | 2006-05-22 |
| Last Update Date | 2018-12-05 |