| NPI | 1831193291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NM PSY1645) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: DC PSY 100094) |
| 103TC0700X Psychologist, Clinical (Licence: MD 03750) | |
| 103TC0700X Psychologist, Clinical (Licence: AZ 3422) | |
| 103TC0700X Psychologist, Clinical (Licence: IA 001171) | |
| 103TC0700X Psychologist, Clinical (Licence: VA 0810002922) | |
| Enumeration Date | 2005-06-13 |
| Last Update Date | 2022-05-20 |