| NPI | 1396914875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TN 4045) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: OH P.08058) |
| 103TC0700X Psychologist, Clinical (Licence: MI 6301017024) | |
| 103TC0700X Psychologist, Clinical (Licence: IL 071010277) | |
| 103TC0700X Psychologist, Clinical (Licence: TX 38934) | |
| 103TC0700X Psychologist, Clinical (Licence: IN 20042232A) | |
| Enumeration Date | 2008-02-28 |
| Last Update Date | 2024-06-17 |