| NPI | 1922745074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: SC 1761) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA 33220) |
| Enumeration Date | 2022-05-18 |
| Last Update Date | 2022-11-21 |