| NPI | 1376803304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NC 4316) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NC 102966) |
| Enumeration Date | 2012-05-24 |
| Last Update Date | 2023-03-21 |