| NPI | 1013936228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: AZ 3463) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: NC 1008) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2007-07-08 |