| NPI | 1619502846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MO 2020030184) |
| 103TC0700X Psychologist, Clinical (Licence: FL PY11347) | |
| Enumeration Date | 2020-03-09 |
| Last Update Date | 2023-02-17 |