| NPI | 1013170828 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: HI 1158) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: CO 3354) |
| Enumeration Date | 2008-07-02 |
| Last Update Date | 2012-12-21 |