| NPI | 1124078316 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NE 419) |
| Additional Taxonomies | 103TA0700X Psychologist, Adult Development & Aging (Licence: NE 419) |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2011-06-29 |