| NPI | 1356786917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: SD 508) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: SD 508) |
| Enumeration Date | 2013-05-08 |
| Last Update Date | 2024-04-15 |