| NPI | 1881672939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: FL PY8583) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: RI PS00496) |
| Enumeration Date | 2006-01-08 |
| Last Update Date | 2012-10-12 |