| NPI | 1184731572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: SC 358) |
| Additional Taxonomies | 103TH0004X Psychologist Health (Licence: NC 3346) |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2007-07-11 |