| NPI | 1871746925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NM 1253) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MO 2008015697) |
| Enumeration Date | 2008-11-02 |
| Last Update Date | 2013-01-24 |