| NPI | 1376577486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TN 3403) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NE 609) |
| 103T00000X Psychologist (Licence: FL PY8028) | |
| 103TC0700X Psychologist, Clinical (Licence: FL PY8028) | |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2021-07-07 |