| NPI | 1336478692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: SC 1313) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NC 3787) |
| Enumeration Date | 2009-12-16 |
| Last Update Date | 2020-02-14 |