| NPI | 1891258398 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VA 0805002162) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: VA 0805002162) |
| Enumeration Date | 2019-04-11 |
| Last Update Date | 2021-07-29 |