| NPI | 1528114436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CA PSY25658) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: NJ 35SI00454800) |
| 103TC0700X Psychologist Clinical (Licence: NY 017251) | |
| Enumeration Date | 2007-01-25 |
| Last Update Date | 2013-05-17 |