| NPI | 1376551291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MD 01526) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MD 1526) |
| Enumeration Date | 2006-08-04 |
| Last Update Date | 2022-03-01 |