| NPI | 1700066560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VA 0810009130) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: VA 0810009130) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: CO CO1479) | |
| Enumeration Date | 2007-11-09 |
| Last Update Date | 2026-05-06 |