| NPI | 1912153800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NC 3665) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MO 2004029370) |
| Enumeration Date | 2008-08-12 |
| Last Update Date | 2012-01-10 |