| NPI | 1316047061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MO PYR0366) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: MO PYR0366) |
| 103TF0000X Psychologist Family (Licence: MO PYR0366) | |
| Enumeration Date | 2006-09-23 |
| Last Update Date | 2022-07-21 |