| NPI | 1699167726 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MD 06736) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: AZ 4600) |
| Enumeration Date | 2015-02-26 |
| Last Update Date | 2024-06-28 |