| NPI | 1639232325 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: SD 511) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: WY 372) |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2013-09-03 |