| NPI | 1366673113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: UT 7252553-2501) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: UT 7252553-2504) |
| Enumeration Date | 2009-07-28 |
| Last Update Date | 2010-07-13 |