| NPI | 1366518375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MO MOPY1237) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: KS 658) |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2007-07-08 |