| NPI | 1912924853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NM PSY1543) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: HI PSY722) |
| 103T00000X Psychologist (Licence: AZ 4061) | |
| Enumeration Date | 2006-07-16 |
| Last Update Date | 2019-01-29 |