| NPI | 1417264912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VA 0810005383) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: GA 003398) |
| Enumeration Date | 2010-09-03 |
| Last Update Date | 2020-10-21 |