| NPI | 1144361544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MD 02457) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NM 723) |
| 103TS0200X Psychologist, School (Licence: NM 267420) | |
| Enumeration Date | 2007-02-09 |
| Last Update Date | 2014-11-12 |