| NPI | 1750301354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PA PS008395 L) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: OH 5046) |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2007-07-09 |