| NPI | 1124103858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MI 6301002566) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: MI 6301002566) |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2007-07-08 |