| NPI | 1952486847 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OR 1425) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: OR AC00792) |
| Enumeration Date | 2006-10-26 |
| Last Update Date | 2011-08-02 |