| NPI | 1245226745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MO PY00348) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: MO PY00348) |
| 103TH0100X Psychologist Health Service (Licence: MO PY00348) | |
| Enumeration Date | 2005-09-21 |
| Last Update Date | 2007-07-08 |