| NPI | 1396797213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 103TA0700X Psychologist Adult Development & Aging |
| Additional Taxonomies | 103TB0200X Psychologist Cognitive & Behavioral |
| 103TC0700X Psychologist Clinical | |
| 103TC2200X Psychologist Clinical Child & Adolescent | |
| 103TR0400X Psychologist Rehabilitation | |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2007-07-08 |