| NPI | 1265769541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OR 2408) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: FL PY8699) |
| Enumeration Date | 2009-11-07 |
| Last Update Date | 2014-03-24 |