| NPI | 1770697336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NC 3289) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: TN P00956) |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2007-07-09 |