| NPI | 1447036868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VA 0810008321) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MA PSY10000742) |
| 103TC0700X Psychologist, Clinical (Licence: VA 0805002488) | |
| Enumeration Date | 2023-09-01 |
| Last Update Date | 2024-05-17 |