| NPI | 1689852709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TH0100X Psychologist Health Service (Licence: NM 0966) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: NM 0966) |
| Enumeration Date | 2008-01-31 |
| Last Update Date | 2008-04-23 |