| NPI | 1568602027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MA 11470) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: AK 682) |
| Enumeration Date | 2009-02-24 |
| Last Update Date | 2023-10-16 |