| NPI | 1316246937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OR 3238) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CO PSY.0005193) |
| Enumeration Date | 2011-03-22 |
| Last Update Date | 2025-05-13 |