| NPI | 1558372839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: KS 2587) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NE 306) |
| Enumeration Date | 2006-08-11 |
| Last Update Date | 2024-04-16 |