| NPI | 1699838342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MT 331) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: ID 202357) |
| Enumeration Date | 2006-12-17 |
| Last Update Date | 2023-11-27 |