| NPI | 1336323534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: TN 2810) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: TN 2810) |
| Enumeration Date | 2007-12-24 |
| Last Update Date | 2008-01-23 |