| NPI | 1417277211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MO 2009004749) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MO 2009004749) |
| Enumeration Date | 2010-06-03 |
| Last Update Date | 2022-03-22 |