| NPI | 1649253956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: GA 2558) |
| Additional Taxonomies | 103TH0004X Psychologist, Health (Licence: GA 2558) |
| Enumeration Date | 2005-11-22 |
| Last Update Date | 2024-10-13 |