| NPI | 1083671374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: DC LC303264) |
| Additional Taxonomies | 103TP2701X Psychologist, Group Psychotherapy (Licence: DC LC303264) |
| Enumeration Date | 2006-04-28 |
| Last Update Date | 2007-07-08 |