| NPI | 1295015196 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NC 5828) |
| Additional Taxonomies | 101Y00000X Counselor |
| 103G00000X Clinical Neuropsychologist (Licence: NC 5828) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA PS018090) | |
| Enumeration Date | 2011-08-23 |
| Last Update Date | 2023-01-10 |