| NPI | 1508003195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: KY 239702) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: IN 20043751A) |
| Enumeration Date | 2009-01-19 |
| Last Update Date | 2023-12-07 |