| NPI | 1720279623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NC 0271) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NC 0271) |
| Enumeration Date | 2007-08-06 |
| Last Update Date | 2011-10-05 |