| NPI | 1760445977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MA 6826) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MA 6826) |
| Enumeration Date | 2006-04-10 |
| Last Update Date | 2024-07-12 |