| NPI | 1508312505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WI 5075-57) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CO PSY.0005986) |
| Enumeration Date | 2016-08-30 |
| Last Update Date | 2024-12-05 |