| NPI | 1649618307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: UT 8800479-2501) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: ID SE-202721) |
| Enumeration Date | 2013-06-04 |
| Last Update Date | 2013-10-23 |