| NPI | 1912258930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: MO 2012033816) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MO 2012033816) |
| Enumeration Date | 2012-10-01 |
| Last Update Date | 2024-01-17 |