| NPI | 1386740744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NH 813) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MA 7015) |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2007-07-09 |