| NPI | 1558621797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: IA 083131) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: IA 083131) |
| Enumeration Date | 2012-05-22 |
| Last Update Date | 2024-02-16 |