| NPI | 1316240583 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OR 2739) |
| Additional Taxonomies | 103TF0200X Psychologist, Forensic (Licence: OR 2739) |
| Enumeration Date | 2010-12-10 |
| Last Update Date | 2018-10-13 |