| NPI | 1861688384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VA 0810005996) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CO 0004017) |
| 103TC0700X Psychologist, Clinical (Licence: CA PSY29380) | |
| Enumeration Date | 2007-09-18 |
| Last Update Date | 2018-07-20 |