| NPI | 1154332260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: PA PS009189L) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: OH 5260) |
| Enumeration Date | 2006-08-11 |
| Last Update Date | 2007-07-08 |