| NPI | 1841420007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: KY 1563) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: GA psy003293) |
| Enumeration Date | 2009-07-22 |
| Last Update Date | 2010-08-11 |