| NPI | 1518984095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TA0700X Psychologist, Adult Development & Aging (Licence: AZ SW 0283I) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: AZ SW 0283I) |
| 1041C0700X Social Worker, Clinical (Licence: AZ SW 0283I) | |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2007-07-08 |