| NPI | 1649267030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MA 3261) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NH 423) |
| Enumeration Date | 2005-09-30 |
| Last Update Date | 2020-03-04 |