| NPI | 1316979024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MA 8526) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MA 8526) |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2014-11-24 |