| NPI | 1083695340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 103TA0700X Psychologist Adult Development & Aging (Licence: NC 1529) |
| Additional Taxonomies | 103TB0200X Psychologist Cognitive & Behavioral (Licence: NC 1529) |
| 103TC0700X Psychologist Clinical (Licence: NC 1529) | |
| Enumeration Date | 2005-11-14 |
| Last Update Date | 2007-07-09 |