| NPI | 1679522353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TH0100X Psychologist, Health Service (Licence: MO R0156) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: IL 071-003792) |
| 103TH0100X Psychologist, Health Service (Licence: IN 20010413A) | |
| Enumeration Date | 2006-05-09 |
| Last Update Date | 2007-07-08 |