| NPI | 1215900576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: HI 1484) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CO 1911) |
| Enumeration Date | 2006-02-08 |
| Last Update Date | 2016-10-18 |