| NPI | 1942226725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VA 0810005907) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: PR 2436) |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2024-04-02 |