| NPI | 1467505214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: AZ 3190) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: AZ 3190) |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2007-07-09 |