| NPI | 1124120225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: SC 415) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: SC 415) |
| 103TC1900X Psychologist, Counseling (Licence: SC 415) | |
| Enumeration Date | 2006-09-01 |
| Last Update Date | 2007-07-08 |