| NPI | 1699976043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NM 0909) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: AZ 3507) |
| Enumeration Date | 2007-05-31 |
| Last Update Date | 2024-09-26 |