| NPI | 1538706940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NH 7118) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MA PSY10001697) |
| Enumeration Date | 2019-12-04 |
| Last Update Date | 2026-05-10 |