| NPI | 1609931351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NV PY0767) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: VA 0811000974) |
| 103TC0700X Psychologist, Clinical (Licence: VA 0810003855) | |
| Enumeration Date | 2006-12-22 |
| Last Update Date | 2021-11-11 |