| NPI | 1598968349 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NC 4093) |
| Additional Taxonomies | 103TH0100X Psychologist Health Service (Licence: NC 4093) |
| 103T00000X Psychologist (Licence: SC 867) | |
| Enumeration Date | 2007-06-08 |
| Last Update Date | 2011-10-17 |