| NPI | 1023180486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MA 3139) |
| Additional Taxonomies | 103TF0000X Psychologist, Family (Licence: MA 3139) |
| 103T00000X Psychologist (Licence: MA 3139) | |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2007-07-08 |