| NPI | 1730227901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NC 0370) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NC 0370) |
| Enumeration Date | 2007-02-01 |
| Last Update Date | 2013-07-12 |