| NPI | 1609043223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WY 152) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: WY 152) |
| Enumeration Date | 2008-05-13 |
| Last Update Date | 2008-05-13 |