| NPI | 1942348487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MD 01189) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: DC PSY964) |
| Enumeration Date | 2007-02-04 |
| Last Update Date | 2007-07-08 |