| NPI | 1679790042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MT 394) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CO PSY2788) |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2010-04-13 |