| NPI | 1861477457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: GA PSY002266) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: FL PY0005263) |
| Enumeration Date | 2005-12-07 |
| Last Update Date | 2007-07-09 |