| NPI | 1609847136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VA 0810000262) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: FL PY10639) |
| Enumeration Date | 2006-02-01 |
| Last Update Date | 2022-08-09 |