| NPI | 1699142851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA 30168) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: GA PSY003876) |
| 103TC0700X Psychologist, Clinical (Licence: MA 10161) | |
| Enumeration Date | 2015-08-24 |
| Last Update Date | 2018-08-07 |