| NPI | 1366461014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MD 03714) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: MD 3714) |
| 103TC0700X Psychologist, Clinical (Licence: VA 0810003695) | |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2008-11-05 |