| NPI | 1285674945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NV PY0166) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA PSY11117) |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2014-05-09 |