| NPI | 1124157599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NC 1680) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: SC 550) |
| Enumeration Date | 2007-03-03 |
| Last Update Date | 2007-07-08 |