| NPI | 1740436633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CO 3239) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: AZ 3603) |
| Enumeration Date | 2008-08-12 |
| Last Update Date | 2008-11-12 |