| NPI | 1023038395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IA 1075) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: TX 32948) |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2009-03-20 |