| NPI | 1902902778 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: AL 1209) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: GA PSY002541) |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2007-07-12 |