| NPI | 1710542428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MO R0176) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: FL PY10426) |
| Enumeration Date | 2019-05-08 |
| Last Update Date | 2019-05-08 |