| NPI | 1477106839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: NC 5549) |
| Additional Taxonomies | 103TF0200X Psychologist Forensic (Licence: NC 5549) |
| Enumeration Date | 2019-07-24 |
| Last Update Date | 2019-07-24 |