| NPI | 1699215376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: PR 5756) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist (Licence: PR 4065) |
| Enumeration Date | 2017-03-01 |
| Last Update Date | 2019-02-27 |