| NPI | 1457445140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: AZ 3339) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: ID 497) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2010-09-02 |