| NPI | 1588943781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: NH 1321) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NH 1321) |
| Enumeration Date | 2011-08-05 |
| Last Update Date | 2019-03-20 |