| NPI | 1568564375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: WV 865) |
| Additional Taxonomies | 103TF0000X Psychologist Family (Licence: WV 865) |
| Enumeration Date | 2006-09-02 |
| Last Update Date | 2016-04-20 |