| NPI | 1093048241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NC 4382) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: OR 2078) |
| Enumeration Date | 2009-09-04 |
| Last Update Date | 2013-01-03 |