| NPI | 1609875285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TA0700X Psychologist, Adult Development & Aging (Licence: WY 238) |
| Additional Taxonomies | 103TA0700X Psychologist, Adult Development & Aging (Licence: CO 492) |
| 103TC0700X Psychologist, Clinical (Licence: WY 238) | |
| 103TC0700X Psychologist, Clinical (Licence: CO 492) | |
| Enumeration Date | 2005-07-18 |
| Last Update Date | 2007-07-08 |