| NPI | 1184661084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NC 5203) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: MS 28-387) |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2017-11-27 |