| NPI | 1316485469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: LA 1401) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: LA 1401) |
| 103TH0004X Psychologist, Health (Licence: LA 1401) | |
| 103TA0700X Psychologist, Adult Development & Aging (Licence: LA 1401) | |
| Enumeration Date | 2017-02-09 |
| Last Update Date | 2017-02-09 |