| NPI | 1780754895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PA PS005110L) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CO 2993) |
| 103T00000X Psychologist | |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2007-07-08 |