| NPI | 1366493769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NM #675) |
| Additional Taxonomies | 103TH0100X Psychologist, Health Service (Licence: NM 675) |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2011-12-29 |