| NPI | 1568826998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: ID 7471153) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: KS 2401) |
| Enumeration Date | 2016-04-12 |
| Last Update Date | 2025-05-06 |