| NPI | 1477525335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CO 3058) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MD 3510) |
| 103TC0700X Psychologist, Clinical (Licence: AL 860) | |
| Enumeration Date | 2006-02-06 |
| Last Update Date | 2007-07-26 |