| NPI | 1356490361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CT 003752) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NC 2274) |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2022-09-26 |