| NPI | 1548314776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TF0200X Psychologist Forensic (Licence: MA 7252) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: MA 7252) |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2023-02-22 |