| NPI | 1669876074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MA 10000) |
| Additional Taxonomies | 103TH0004X Psychologist, Health (Licence: MA 10000) |
| Enumeration Date | 2014-10-14 |
| Last Update Date | 2014-10-14 |