| NPI | 1972546992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MO 2021031964) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: RI PS00758) |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2022-09-12 |