| NPI | 1598032401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NE 805) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: IA 077703) |
| 103TC0700X Psychologist, Clinical (Licence: MN LP5438) | |
| Enumeration Date | 2011-11-20 |
| Last Update Date | 2018-05-17 |