| NPI | 1841395654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VA 0810003678) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MD 04193) |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2007-07-08 |