| NPI | 1689905192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PR 3660) |
| Additional Taxonomies | 174400000X Specialist (Licence: PR 3660) |
| Enumeration Date | 2010-01-22 |
| Last Update Date | 2011-06-23 |