| NPI | 1508097601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: SC 1349) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: CT 002518) |
| Enumeration Date | 2009-08-06 |
| Last Update Date | 2015-04-21 |