| NPI | 1336188697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TH0004X Psychologist, Health (Licence: PA PS004517L) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: PA PS004517L) |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2007-12-13 |