| NPI | 1598045841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MD 05275) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: VA 0810004819) |
| Enumeration Date | 2011-08-18 |
| Last Update Date | 2014-03-25 |