| NPI | 1679526750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NC 404) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: NC 404) |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2008-07-30 |