| NPI | 1366403677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IA 00404) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: IA 00911) |
| Enumeration Date | 2006-03-28 |
| Last Update Date | 2007-12-21 |