| NPI | 1972944585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MA 11090) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical |
| Enumeration Date | 2013-07-11 |
| Last Update Date | 2019-10-10 |