| NPI | 1669469904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: AZ 880) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CO 1076) |
| Enumeration Date | 2005-10-03 |
| Last Update Date | 2007-07-08 |