| NPI | 1730520602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MA 9840) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MA 9840) |
| Enumeration Date | 2013-07-08 |
| Last Update Date | 2023-03-29 |