| NPI | 1356632582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NC 1738) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NC 13823) |
| Enumeration Date | 2011-04-21 |
| Last Update Date | 2019-12-16 |