| NPI | 1104882927 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WI 1639-57) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: WI 31440-020) |
| Enumeration Date | 2006-04-21 |
| Last Update Date | 2011-01-19 |