| NPI | 1538117080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MO R0378) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: ND 253) |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2007-07-08 |