| NPI | 1346573185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WV 1290) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MD 05133) |
| Enumeration Date | 2009-09-11 |
| Last Update Date | 2022-10-17 |