| NPI | 1972167161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VA 0810007310) |
| Additional Taxonomies | 103TH0004X Psychologist, Health |
| Enumeration Date | 2019-04-24 |
| Last Update Date | 2020-12-01 |