| NPI | 1538300025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TA0700X Psychologist Adult Development & Aging |
| Additional Taxonomies | 103T00000X Psychologist |
| 103TC0700X Psychologist Clinical (Licence: NC 650) | |
| 103TC2200X Psychologist Clinical Child & Adolescent | |
| 103TE1100X Psychologist Exercise & Sports | |
| 103TH0100X Psychologist Health Service | |
| 103TR0400X Psychologist Rehabilitation | |
| Enumeration Date | 2009-03-13 |
| Last Update Date | 2020-04-08 |