| NPI | 1811198807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WI 0439) |
| Additional Taxonomies | 103TA0700X Psychologist, Adult Development & Aging |
| 103TB0200X Psychologist, Cognitive & Behavioral | |
| 103TC0700X Psychologist, Clinical (Licence: WI 0439) | |
| 103TF0200X Psychologist, Forensic | |
| 103TH0100X Psychologist, Health Service | |
| Enumeration Date | 2007-05-29 |
| Last Update Date | 2007-07-08 |