| NPI | 1043460165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: NC 1004) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NC 1004) |
| Enumeration Date | 2008-09-25 |
| Last Update Date | 2008-09-25 |