| NPI | 1922479641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NC 5042) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: VA 0810005241) |
| Enumeration Date | 2015-10-08 |
| Last Update Date | 2016-11-06 |