| NPI | 1144386814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TB0200X Psychologist Cognitive & Behavioral (Licence: MO 2006006594) |
| Additional Taxonomies | 103TB0200X Psychologist Cognitive & Behavioral (Licence: TX 31149) |
| Enumeration Date | 2006-12-28 |
| Last Update Date | 2008-01-29 |