| NPI | 1902335623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CT 3659) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 021732) |
| 103TC0700X Psychologist, Clinical (Licence: NC 4876) | |
| 103TC0700X Psychologist, Clinical (Licence: WA PY60602588) | |
| Enumeration Date | 2017-06-06 |
| Last Update Date | 2018-04-25 |