| NPI | 1770632515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TH0004X Psychologist Health (Licence: SC 1469) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: AL 773) |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2018-03-17 |