| NPI | 1881363513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MA 11750) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: SC 1398) |
| Enumeration Date | 2021-09-07 |
| Last Update Date | 2022-05-04 |