| NPI | 1427029008 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 103TF0200X Psychologist Forensic (Licence: MA 3620) |
| Additional Taxonomies | 103TF0200X Psychologist Forensic (Licence: FL PY 6871) |
| Enumeration Date | 2006-01-31 |
| Last Update Date | 2007-07-08 |