| NPI | 1891264313 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MD 06186) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: VA 0810-006038) |
| Enumeration Date | 2018-11-14 |
| Last Update Date | 2018-11-14 |