| NPI | 1952555351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MO 2018005289) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: AZ 3962) |
| Enumeration Date | 2008-11-11 |
| Last Update Date | 2019-03-22 |