| NPI | 1407066293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MD 01048) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MD 01048) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2008-03-25 |