| NPI | 1346277829 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IA 00960) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral |
| 103TH0004X Psychologist, Health (Licence: IA 000498) | |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2021-04-12 |