| NPI | 1427643717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MD 06757) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: WI 3930-57) |
| Enumeration Date | 2021-03-08 |
| Last Update Date | 2022-08-31 |