| NPI | 1215910591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NM 1105) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CO 1937) |
| Enumeration Date | 2005-11-21 |
| Last Update Date | 2010-01-26 |