| NPI | 1124340732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TF0200X Psychologist, Forensic (Licence: OK 1118) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: OK 1118) |
| 103TC1900X Psychologist, Counseling (Licence: OK 1118) | |
| Enumeration Date | 2010-02-23 |
| Last Update Date | 2011-05-10 |