| NPI | 1699810879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: ND 393) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: SD 490) |
| Enumeration Date | 2007-02-21 |
| Last Update Date | 2010-06-29 |