| NPI | 1306929831 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY0006361) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: LA 796) |
| Enumeration Date | 2006-10-20 |
| Last Update Date | 2008-03-17 |