| NPI | 1518986108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: GA PSY003088) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: HI PSY-983) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2008-03-17 |