| NPI | 1285058453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WV 1083) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: WV 1083) |
| Enumeration Date | 2014-02-09 |
| Last Update Date | 2014-02-10 |