| NPI | 1720311467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TH0004X Psychologist, Health (Licence: WI 3049-57) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: WI 3049-57) |
| Enumeration Date | 2009-09-14 |
| Last Update Date | 2012-10-29 |