| NPI | 1689230872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VA 0810006441) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: AL None) |
| Enumeration Date | 2019-05-14 |
| Last Update Date | 2020-12-23 |