| NPI | 1952583478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: NC 3159) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: GA 2961) |
| Enumeration Date | 2007-11-27 |
| Last Update Date | 2013-06-03 |