| NPI | 1598733099 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MO R0196) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MO R0196) |
| Enumeration Date | 2006-03-09 |
| Last Update Date | 2012-09-20 |