| NPI | 1275585606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: AR 0318P) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: AK 646) |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2015-09-29 |