| NPI | 1518016146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NC 4987) |
| Additional Taxonomies | 103TF0200X Psychologist, Forensic (Licence: NC 4987) |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2022-06-10 |