| NPI | 1336158161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PA PS016111) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: OH 4726) |
| 103TC0700X Psychologist, Clinical (Licence: VA 0810001581) | |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2011-08-04 |