| NPI | 1780969980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: CO PSY.0004917) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MO 2011031533) |
| Enumeration Date | 2011-10-19 |
| Last Update Date | 2018-12-17 |