| NPI | 1922217462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: DE B1 0000321) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: PA PS-003891-L) |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2007-07-08 |