| NPI | 1417923939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: OR 1374) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: OR 629) |
| Enumeration Date | 2006-02-24 |
| Last Update Date | 2007-07-08 |