| NPI | 1316361520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY8140) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA PSY21786) |
| Enumeration Date | 2014-02-07 |
| Last Update Date | 2014-02-07 |