| NPI | 1720317449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: AL 1060) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: NM 0927) |
| Enumeration Date | 2009-12-08 |
| Last Update Date | 2009-12-08 |