| NPI | 1902046964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL 10142) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: PR 2388) |
| Enumeration Date | 2009-03-03 |
| Last Update Date | 2020-08-17 |