| NPI | 1558708461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: OR 3084) |
| Additional Taxonomies | 103TB0200X Psychologist Cognitive & Behavioral |
| Enumeration Date | 2013-05-31 |
| Last Update Date | 2024-06-20 |