| NPI | 1538211230 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MO 2003030098) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MO 2003030098) |
| 103TF0200X Psychologist, Forensic (Licence: MO 2003030098) | |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2017-03-28 |