| NPI | 1679500177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MA 6621) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NH 990) |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2007-07-08 |