| NPI | 1073605267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MO Psychology 01224) |
| Additional Taxonomies | 103TF0000X Psychologist, Family |
| 103T00000X Psychologist (Licence: MO Psychology 01224) | |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2007-07-08 |