| NPI | 1811144777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PR 3090) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: VA 0810004564) |
| Enumeration Date | 2008-08-22 |
| Last Update Date | 2013-01-16 |