| NPI | 1356554000 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: ND 563P) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: WY 444) |
| 103TC0700X Psychologist Clinical (Licence: CO 3094) | |
| 103TC0700X Psychologist Clinical (Licence: MN 6144) | |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2019-05-07 |