| NPI | 1437515962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: HI PSY-225-0) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: OR 3236) |
| Enumeration Date | 2016-01-13 |
| Last Update Date | 2024-11-07 |