| NPI | 1578949103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PA PS019049) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA 30630) |
| Enumeration Date | 2015-08-05 |
| Last Update Date | 2020-12-30 |