| NPI | 1013120781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MD 04322) |
| Additional Taxonomies | 103TA0700X Psychologist, Adult Development & Aging (Licence: MD 04322) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: MD 04322) | |
| 103TC0700X Psychologist, Clinical (Licence: MD 04322) | |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2010-10-15 |