| NPI | 1902914344 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CO 2621) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: NE 637) |
| Enumeration Date | 2006-08-27 |
| Last Update Date | 2009-10-30 |