| NPI | 1821099862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: IA 00229) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: IA 00377) |
| Enumeration Date | 2005-08-01 |
| Last Update Date | 2007-07-08 |