| NPI | 1811285554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MD 03181) |
| Additional Taxonomies | 103TB0200X Psychologist Cognitive & Behavioral (Licence: MD 03181) |
| Enumeration Date | 2011-07-15 |
| Last Update Date | 2011-07-15 |