| NPI | 1235108994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WY 278) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CO 1816) |
| Enumeration Date | 2006-03-15 |
| Last Update Date | 2016-04-29 |