| NPI | 1215943766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NC C000817) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: NC C000817) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2007-07-08 |