| NPI | 1790700342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: AR 0412P) |
| Additional Taxonomies | 103TF0200X Psychologist, Forensic (Licence: AR 0412P) |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2023-10-09 |