| NPI | 1871730390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NH 00015) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CO 2872) |
| Enumeration Date | 2009-01-21 |
| Last Update Date | 2021-03-24 |