| NPI | 1497859888 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: OR 1146) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: OR 1146) |
| Enumeration Date | 2006-09-07 |
| Last Update Date | 2024-11-21 |