| NPI | 1891861530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NC 3958) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: TN 2751) |
| Enumeration Date | 2006-11-27 |
| Last Update Date | 2011-09-21 |