| NPI | 1972841484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MO 2017010362) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: VA 0810004701) |
| Enumeration Date | 2013-01-18 |
| Last Update Date | 2025-10-09 |