| NPI | 1689749756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MA 7975) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: FL 4773) |
| Enumeration Date | 2006-11-22 |
| Last Update Date | 2007-07-08 |