| NPI | 1689705741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NC 2653) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: SC 0748) |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2007-07-08 |