| NPI | 1932649704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: PR 5860) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist (Licence: PR 4084) |
| Enumeration Date | 2017-02-27 |
| Last Update Date | 2019-02-27 |