| NPI | 1760591333 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: VT 0480000264) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NC 0645) |
| 103T00000X Psychologist (Licence: FL PY5922) | |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2007-07-08 |