| NPI | 1073757761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MO 2016024854) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: OH 6470) |
| 103T00000X Psychologist (Licence: TX 34234) | |
| 103T00000X Psychologist (Licence: KS 2422) | |
| Enumeration Date | 2009-04-24 |
| Last Update Date | 2016-07-19 |