| NPI | 1699710509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: NH 941) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: MA 7920) |
| Enumeration Date | 2006-06-17 |
| Last Update Date | 2021-09-21 |