| NPI | 1295788388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: GA PSY004549) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MO PYR0266) |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2022-02-03 |