| NPI | 1457457053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NC 4158) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: FL PY 7202) |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2018-04-05 |