| NPI | 1437281680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VA 0810004720) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: AL 1702) |
| Enumeration Date | 2007-03-12 |
| Last Update Date | 2022-09-28 |