| NPI | 1477529980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TB0200X Psychologist Cognitive & Behavioral (Licence: SC 282) |
| Additional Taxonomies | 103TC1900X Psychologist Counseling (Licence: SC 282) |
| Enumeration Date | 2006-02-24 |
| Last Update Date | 2008-10-02 |