| NPI | 1528272937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PA PS016715) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: ME PE1156) |
| Enumeration Date | 2007-05-09 |
| Last Update Date | 2010-01-04 |