| NPI | 1982097614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: AZ 4564) |
| Additional Taxonomies | 103TA0700X Psychologist, Adult Development & Aging (Licence: AZ 4564) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: AZ 4564) | |
| 103TC1900X Psychologist, Counseling (Licence: AZ 4564) | |
| 103TH0004X Psychologist, Health (Licence: AZ 4564) | |
| Enumeration Date | 2015-03-04 |
| Last Update Date | 2015-10-04 |