| NPI | 1548977507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: GA notcompletedyet) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: GA not.yet.completed) |
| Enumeration Date | 2022-10-31 |
| Last Update Date | 2022-11-22 |