| NPI | 1811693351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: ID PSY203864) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MN LP6892) |
| Enumeration Date | 2023-02-06 |
| Last Update Date | 2024-08-14 |