| NPI | 1306914643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OR 2540) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: OR 1804) |
| 103TC0700X Psychologist, Clinical (Licence: ID PSY202444) | |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2014-12-18 |