| NPI | 1861584385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: SD 232) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: UT 112299) |
| Enumeration Date | 2006-09-29 |
| Last Update Date | 2011-04-04 |