| NPI | 1568436459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: FL 8061) |
| Additional Taxonomies | 103TF0200X Psychologist Forensic (Licence: FL 8061) |
| Enumeration Date | 2006-02-15 |
| Last Update Date | 2021-02-10 |