| NPI | 1285163543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: FL PY10595) |
| Additional Taxonomies | 103TH0004X Psychologist, Health (Licence: FL PY10595) |
| 103TC0700X Psychologist, Clinical (Licence: FL PY10595) | |
| 103TH0100X Psychologist, Health Service (Licence: FL PY10595) | |
| Enumeration Date | 2017-06-08 |
| Last Update Date | 2022-05-23 |