| NPI | 1396805016 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OR 3970) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: SD 250) |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2025-11-12 |