| NPI | 1396930236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NE 513) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NE 513) |
| Enumeration Date | 2007-09-13 |
| Last Update Date | 2022-06-10 |