| NPI | 1508007436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: AL 1984) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: AK 669) |
| Enumeration Date | 2009-03-24 |
| Last Update Date | 2019-10-28 |