| NPI | 1003982174 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NM 1174) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NH 864) |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2014-09-05 |