| NPI | 1831171065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: GA 663) |
| Additional Taxonomies | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: GA 663) |
| 103TF0000X Psychologist Family (Licence: GA 663) | |
| 103T00000X Psychologist (Licence: GA 663) | |
| Enumeration Date | 2005-11-15 |
| Last Update Date | 2007-07-09 |