| NPI | 1780223081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TF0200X Psychologist, Forensic (Licence: NC 3176) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NC 3176) |
| Enumeration Date | 2020-01-03 |
| Last Update Date | 2020-01-03 |