| NPI | 1003993635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: MI 6301006738) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MI 6301006738) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2007-07-08 |