| NPI | 1851362362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: TX 39425) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: PA PS015066) |
| 103TC0700X Psychologist Clinical (Licence: NC 5401) | |
| 103TC0700X Psychologist Clinical (Licence: VA 0810006008) | |
| Enumeration Date | 2006-02-01 |
| Last Update Date | 2024-10-02 |