| NPI | 1124024187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: AR 72-5P) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: TX 2-1477) |
| Enumeration Date | 2005-06-24 |
| Last Update Date | 2007-07-08 |