| NPI | 1699078295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MA 9282) |
| Additional Taxonomies | 103TH0100X Psychologist Health Service (Licence: MA 9282) |
| Enumeration Date | 2010-12-21 |
| Last Update Date | 2018-07-18 |