| NPI | 1477544039 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MT 270) |
| Additional Taxonomies | 103TS0200X Psychologist School (Licence: MT 45407) |
| Enumeration Date | 2005-11-02 |
| Last Update Date | 2016-03-08 |