| NPI | 1366060303 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NV PY1014) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: AZ PSY-005394) |
| Enumeration Date | 2020-07-07 |
| Last Update Date | 2021-09-27 |