| NPI | 1790715431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NC 3214) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NC 3214) |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2010-09-17 |