| NPI | 1316963994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WI 2011-57) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: WI 2011-57) |
| 103TH0100X Psychologist, Health Service (Licence: WI 2011-57) | |
| Enumeration Date | 2006-07-15 |
| Last Update Date | 2020-02-18 |