| NPI | 1366488132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: ID Psy163) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: ID LMFT2954) |
| Enumeration Date | 2006-06-21 |
| Last Update Date | 2007-07-08 |