| NPI | 1972501914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CT 001441) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CT 001441) |
| Enumeration Date | 2005-07-13 |
| Last Update Date | 2022-09-30 |