| NPI | 1780812727 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TH0004X Psychologist Health (Licence: MO 2016032343) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: MO 2016032343) |
| Enumeration Date | 2009-06-29 |
| Last Update Date | 2020-12-04 |