| NPI | 1932227584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CO 1164) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: AK 400) |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2015-05-12 |