| NPI | 1285828376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PA PS017117) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 103TC0700X Psychologist, Clinical (Licence: MN LP5243) | |
| Enumeration Date | 2007-08-31 |
| Last Update Date | 2015-03-06 |