| NPI | 1720051980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: OR 0732) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: OR 0732) |
| Enumeration Date | 2006-02-08 |
| Last Update Date | 2007-07-08 |