| NPI | 1356460687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CO PSY3846) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: CA PSY22379) |
| Enumeration Date | 2007-03-28 |
| Last Update Date | 2013-02-20 |