| NPI | 1861463440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IA 080046) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NE PhD338) |
| Enumeration Date | 2006-01-31 |
| Last Update Date | 2015-12-15 |