| NPI | 1538331509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: GA 002069) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: GA 0002069) |
| Enumeration Date | 2008-03-30 |
| Last Update Date | 2016-02-16 |