| NPI | 1922143569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CT 602) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MA 1354) |
| Enumeration Date | 2007-02-21 |
| Last Update Date | 2017-03-15 |