| NPI | 1912023623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NC 3361) |
| Additional Taxonomies | 103TF0200X Psychologist, Forensic (Licence: FL PY6178) |
| Enumeration Date | 2007-03-22 |
| Last Update Date | 2023-11-20 |