| NPI | 1780624437 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NC 1307) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: NC 1307) |
| 103TC0700X Psychologist, Clinical (Licence: NC 1307) | |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2013-06-17 |