| NPI | 1932325685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MD 3932) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: VA 0810003949) |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2026-01-20 |