| NPI | 1285734145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NE 709) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: UT 329152-2501) |
| 103TC0700X Psychologist, Clinical (Licence: WV 866) | |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2009-03-16 |