| NPI | 1891711131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: TN 1706) |
| Additional Taxonomies | 103TR0400X Psychologist Rehabilitation (Licence: TN 1706) |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2009-07-31 |