| NPI | 1972536951 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MO 1295) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: FL 4087) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2007-07-08 |