| NPI | 1316969538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MO R0408) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MO r0408) |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2022-10-05 |