| NPI | 1225222433 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: ID PSY316) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: AZ PSY3208) |
| Enumeration Date | 2007-08-30 |
| Last Update Date | 2012-08-15 |