| NPI | 1699901942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: AZ PSY-4032) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: AZ 4032) |
| Enumeration Date | 2009-06-01 |
| Last Update Date | 2013-01-23 |