| NPI | 1366987075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CO 5506) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 021978) |
| Enumeration Date | 2017-01-04 |
| Last Update Date | 2021-11-11 |