| NPI | 1508265067 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NM PSY1328) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NM 1328) |
| Enumeration Date | 2014-08-20 |
| Last Update Date | 2023-07-06 |