| NPI | 1760584973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WI 1815-057) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: WI 1815057) |
| Enumeration Date | 2006-09-01 |
| Last Update Date | 2008-09-30 |