| NPI | 1497918775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NC 3926) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MD 04606) |
| Enumeration Date | 2008-07-07 |
| Last Update Date | 2022-06-03 |