| NPI | 1770686891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MA 367) |
| Additional Taxonomies | 103TA0700X Psychologist Adult Development & Aging |
| Enumeration Date | 2006-09-06 |
| Last Update Date | 2015-03-12 |